Achieving MeTA Objectives in Ghana

This 14-slide presentation presents the MeTA project process in Ghana for effecting more transparency in the system of pharmaceutical drugs. It explains the kind of difficulties associated with medicine access in Ghana. According to a chart that opens the presentation, 20% of the problem is in access, 40% in drug quality, and 40% in affordability. The MeTA goals are to improve health outcomes for Ghanaians, particularly through enhancing national efforts for transparency in the selection, regulation, registration, procurement, distribution, sales, and rational use of medicines in Ghana.


In order to begin the project, there were 2 scoping missions by the United Kingdom (UK) Department for International Development (DFID), a multi-stakeholder meeting, formation of a core team, and an international launch invitation.


The legislative and policy environment elements of transparency and accountability in Ghana include the following:

• Government and Presidential commitment to good governance;
• Public Procurement Act 2003 & Ministry of Health (MOH) Guidelines for health sector procurement;
• Forthcoming Right to Information Bill;
• History of civil society collaboration with government;
• Data collection and reporting bodies on aspects of pharmaceutical supply chain and use;
• National Health Insurance Scheme (NHIS) - significant opportunities to improve transparency, accountability, pricing, quality.

In the Health Sector Programme of Work 2007-2011, the policy framework for MeTA Ghana, key principles are described as:

1. Health identified as key driver for poverty reduction and economic growth;
2. Emphasis on "partnerships", "people-centred", "equity", and "efficiency";
3. Emphasis on good governance and accountability in the health sector;
4. Plans to proactively engage civil society in consensus building and to provide more information to consumers, e.g., around quality and rational drug use; and
5. Drugs and Essential Logistics Management objective: "address availability, affordability, sustainable financing, safety, quality, and efficacy of medicines in a transparent manner."

The key challenges include: the problem that improved procurement is not translating to affordability and availability of medicine; little information on quality, availability, and prices of medicines results in low consumer awareness; standards of quality, availability, and prices are inconsistently applied; and supply chain problems lead to high out-of-stock rates. A second set of challenges includes: patient non-adherence to treatment and irrational medicine use by providers; vulnerability to fraud of the NIHS; and counterfeit or substandard products.


Among MeTA objects in the pilot phase are the following: establish mechanisms to strengthen the collection, analysis, and dissemination of data on medicines along the supply chain; facilitate peer oversight systems within and across health professions; sustain regular, open stakeholder dialogue; and develop a long-term strategy for MeTA in Ghana.


Proposed strategies are:

1. Assess the level of transparency and good governance in medicine regulation, procurement, distribution, and use.
2. Use World Health Organization (WHO) standard indicators to monitor the prices and availability of medicines, as well as their rational use.
3. Regularly monitor medicines quality through sentinel testing using Global Pharma Health Fund (GPHF) minilabs.
4. Widely publicise data on prices at various points along the supply chain, including those agreed at public tender.
5. Correlate procurement data to stock volumes and the availability of medicines to the consumer.
6. Undertake periodic annual studies to understand and/or explain provider and consumer behaviour.

The presentation describes proposed MeTA governance structures including members of its governing council. It cautions on topics of risk and assumption, such as timeliness and sustainability of financing, nervousness of stakeholders about change, mutual suspicions between government and private sectors, and civil society fragmentation, among other topics.

The following recommendations constitute the means to achieving MeTA goals: accommodate the interests and perceptions of all local stakeholders to reflect its character as a "multi-stakeholder initiative" to achieve the strong commitment of stakeholders; put more focus on "demand-side" initiatives focusing on patient education and advocacy championed by civil society organisations and media; and ensure a MeTA effort that is Ghanaian-ownership-driven.